Impact of switching to new spirometric reference equations on severity staging of airflow obstruction in COPD: a crosssectional observational study in primary care.

Background: Severity of airflow obstruction in chronic obstructive pulmonary disease (COPD) is based on forced expiratory volume in one second expressed as percentage predicted (FEV1%predicted) derived from reference equations for spirometry results.

Aims: To establish how switching to new spirometric reference equations would affect severity staging of airflow obstruction in the Dutch primary care COPD patient population.

Methods: Spirometry tests of 3,370 adults aged >40 years with obstruction (postbronchodilator FEV1/forced vital capacity (FVC) <0.

Diagnostic accuracy of primary care asthma/COPD working hypotheses, a real life study.

Unlabelled: Misdiagnoses are inevitable when working hypotheses of asthma/COPD of General Practitioners (GPs) are not checked by spirometry. To reduce misdiagnoses, Asthma/COPD-support services (AC-services) offer support by performing spirometry assessed together with written medical history by consulting pulmonologists.

Research Questions: Which criteria do GPs use to justify their asthma/COPD working hypotheses? How do diagnostic assessments by an AC-service change GPs' working hypotheses? Do GPs' justifications for their working hypotheses influence the extent to which working hypotheses correspond with diagnoses given by an AC-service?

Method: We investigated the working hypotheses of 17 GPs for 284 patients with respiratory problems and their justifications: "clinical symptoms", "office spirometry", or "specialist's correspondence".

Lung function decline in relation to diagnostic criteria for airflow obstruction in respiratory symptomatic subjects.

Background: Current COPD guidelines advocate a fixed < 0.70 FEV1/FVC cutpoint to define airflow obstruction. We compared rate of lung function decline in respiratory symptomatic 40+ subjects who were 'obstructive' or 'non-obstructive' according to the fixed and/or age and gender specific lower limit of normal (LLN) FEV1/FVC cutpoints.

Effect of lifestyle intervention for people with diabetes or prediabetes in real-world primary care: propensity score analysis.

Background: Many lifestyle interventions for patients with prediabetes or type 2 diabetes mellitus (T2DM) have been investigated in randomised clinical trial settings. However, the translation of these programmes into primary care seems challenging and the prevalence of T2DM is increasing. Therefore, there is an urgent need for lifestyle programmes, developed and shown to be effective in real-world primary care.

Diagnostic assessments of spirometry and medical history data by respiratory specialists supporting primary care: are they reliable?

Aim: To determine the intra- and inter-observer reliability of respiratory specialists' diagnostic assessments of spirometry and written medical history data obtained from primary care.

Method: Five respiratory specialists assessed spirometry data and the history of 156 patients randomly selected from referrals to an asthma/COPD-service. The inter-observer reliability was evaluated.

Effect of an integrated primary care model on the management of middle-aged and old patients with obstructive lung diseases.

Objective: To investigate the effect of a primary care model for COPD on process of care and patient outcome.

Design: Controlled study with delayed intervention in control group.

Setting: The GP delegates tasks to a COPD support service (CSS) and a practice nurse.

Logistic support service improves processes and outcomes of diabetes care in general practice.

Background: Guidelines for type 2 diabetes care in general practice are well known and accepted, but the implementation falls short.

Objective: To implement these guidelines by introducing a diabetes support service (DSS) to support the care delivered by the GP.

Methods: A controlled, non-randomised study with delayed intervention in the control group; 78 GPs (n=51 for the intervention and n=21 for the control group) in the south of the Netherlands and 613 of their type 2 diabetic patients participated.

The feasibility of a primary care model for the management of COPD.

Aims: To investigate the feasibility of a primary care model to improve the management of COPD.

Methods: An intervention study on 1,497 patients with documented COPD from 22 general practices, involving 11 practice nurses and a COPD Support Service (CSS). Outcome measures included the successful delegation of tasks from general practitioners (GPs) to the CSS and practice nurse, and performance in daily practice according to the model components -- keeping a patient register with a recall system, periodical history taking and lung function measurements, asking diagnostic and therapeutic advice, and performing regular follow-up visits with education and counselling.